Method and apparatus for suture anchors with a vertical eyelet

ABSTRACT

A suture anchor for anchoring a suture in the selected portion of an anatomical portion for fixing a suture thereto. The suture anchor including an anatomical engaging portion and a suture engaging portion wherein both the anatomical engaging portion and a suture engaging portion are adapted to be substantially disposed below an exterior of the anatomical portion after implantation. Suture eyelets are provided in the suture engaging section and a suture passage is formed to interconnect the eyelets to allow a suture to be easily threaded in the suture engaging section from the first eyelet to the second eyelet.

FIELD

The present invention relates to suture anchors; and particularly tosuture anchors including suture eyelets formed to eliminate suturecontact with a hole in an anatomy.

BACKGROUND

Surgical or medical procedures are often performed on a body, forexample a human body or anatomy, to repair or replace various portionsthereof. For example, tendons that attach muscle to bone or ligamentsthat attach bones to other bones may be replaced for various reasons.For example, an injury to a ligament, such as a ligament in the leg mayneed to be replaced. Alternatively, the tendon from the muscle maysimply be loosened from its attachment point and need to be reattachedwithout the necessity of a replacement.

Regardless of the reason, soft tissues are often fixed to variouspositions on the bone. For example, to replace a natural tendon fixationpoint or to replace the tendon itself, fixing a graft to a selected bonearea may be desired. One means to fix the soft tissue to the selectedarea is to provide a suture through a selected portion of the softtissue and fix the other end of the suture to a selected area on thebone. Various structures can be provided to anchor or hold the suture inthe selected bone area.

Although suture anchors do provide a member to fix the suture to aselected portion of a boney portion, it is often desired to provide asuture anchor that is able to substantially protect the suture fromengagement with the bone. Generally, suture anchors that are threadedwith a suture do not provide complete protection from engagement of thesuture with the bone in the bore in which the suture is positioned. Thisrequires greater care and precision while implanting the suture anchorthan would otherwise be required.

Also, many suture anchors are substantially difficult to thread orproperly engage with the suture. This is particularly the case when thesuture must be passed through a substantial portion of the sutureanchor. Often, only the eyelets or small bores are the access points tothe suture anchor channel, thus limiting the ability to thread thesuture through the anchor during a surgical procedure. Therefore, it isalso desirable to provide a suture anchor that will providesubstantially easy threading of a suture during a surgical procedure.

SUMMARY

A suture anchor to substantially enclose a portion of the suturethreaded through the suture anchor and thus to substantially eliminatecontact of the suture with the bore into which the suture anchor ispositioned. In addition, the suture anchor generally provides for asubstantially simple or easy threading of the suture during a surgicalprocedure. Generally, the suture is provided in a selected end of thesuture anchor which is driven into a selected portion of the bone. Thesuture anchor may either be self-tapping and drilling or may be placedin a pre-drilled or pre-tapped hole.

Generally, the suture anchor includes a bone engaging section having abone engaging portion such as screw threads, and a non-threaded sutureengaging section, including suture eyelets. A suture passageinterconnects the eyelets within the suture engaging section. The sutureeyelets and passage are substantially contained within the suture anchorsuch that the suture that is positioned through the suture anchor doesnot engage the boney portion but only extends from the suture anchor.Nevertheless, the suture anchor is able to be provided substantially inthe boney structure such that substantially no portion of the sutureanchor extends above a surface of the boney structure.

According to a first embodiment a suture anchor includes a bone engagingsection formed along a bone engaging axis. A bone engaging structure isformed along the bone engaging section and defines a maximum diameter ofthe suture anchor. A suture engaging section extends from the boneengaging section and defines a diameter less than or equal to themaximum diameter. An eyelet is formed in the suture engaging section toallow a selected portion of a suture to pass through and extend from thesuture engaging section generally along the bone engaging axis. A suturepassage is defined by the suture engaging section such that the selectedportion of the suture remains substantially within the maximum diameter.

According to a further embodiment a method of providing a suture in asuture anchor having a bone engaging section and a suture engagingsection with a suture passage formed in the suture engaging section isprovided. The method includes providing a first suture passage sectionextending from a proximal end through a first exterior portion of thesuture engaging section. A second suture passage section is providedthat extends from the first exterior portion through a second exteriorsection of the suture passage. Also, a third suture passage sectionextends from the second suture passage through an exterior portion ofthe proximal end of the suture engaging section. A suture is passedthrough the first suture passage section from the proximal exteriorthrough the first exterior portion. The suture is passed from the firstexterior portion through the second exterior portion. The suture is alsopassed from the second exterior portion through the proximal exteriorportion.

According to a further embodiment a suture anchor to provide a fixationof a suture in a selected anatomical portion includes an anatomicalengaging section having an anatomical engaging portion. A sutureengaging section extends from the anatomical engaging section. Thesuture engaging section defines a first suture eyelet and a secondsuture eyelet. The suture engaging section defines a suture holdingpassage interconnecting the first suture eyelet and second suture eyeletand substantially holding a suture relative to the anatomical engagingsection. The suture engaging section is adapted to be positionedgenerally within a selection portion of the selected anatomical portion.

Further areas of applicability of the present invention will becomeapparent from the detailed description provided hereinafter. It shouldbe understood that the detailed description and specific examples, whileindicating the preferred embodiment of the invention, are intended forpurposes of illustration only and are not intended to limit the scope ofthe invention.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will become more fully understood from thedetailed description and the accompanying drawings, wherein:

FIG. 1 is a side elevational view of a suture anchor according to anembodiment;

FIG. 2 is a side elevational view of a different side of the sutureanchor from FIG. 1;

FIG. 3 is a top elevational view of the suture anchor of FIG. 1;

FIG. 4 is a first side elevational view of the suture anchor accordingto a second embodiment;

FIG. 5 is a second side elevational view of the suture anchor of FIG. 4;

FIG. 6 is a top elevational view of the suture anchor of FIG. 4;

FIG. 7 is a first side elevational view of the suture anchor accordingto a third embodiment;

FIG. 8 is a second side elevational view of the suture anchor of FIG. 7;

FIG. 9 is a top elevational view of the suture anchor of FIG. 7;

FIG. 10 is a cross-sectional view of the suture anchor of FIG. 8;

FIG. 11 is a side elevational view of a suture anchor according to afourth embodiment;

FIG. 12 is a detailed cross-sectional view of the suture anchor of FIG.11;

FIG. 13 is a second side elevational view of the suture anchor of FIG.11;

FIG. 14 is a top elevational view of the suture anchor of FIG. 11;

FIG. 15 is a cross-sectional view take along lines 15-15 of FIG. 13;

FIGS. 16A-16C are a detailed cross-sectional view of the suture engagingsection of the suture embodiment of FIG. 15;

FIG. 17 is an environmental view of a tool engaging a suture anchoraccording to an embodiment; and

FIG. 18 is a detailed cross-sectional view of a suture anchor engaging aboney portion.

FIG. 19 is an exploded view of a suture anchor according to analternative embodiment;

FIG. 20 is an assembled perspective view of the suture anchor of FIG.19;

FIG. 21 is a cross-sectional view of the suture anchor of FIG. 19implanted in a bone;

FIG. 22 is an exploded perspective view of a suture anchor according toan alternative embodiment;

FIG. 23 is an exploded cross-sectional view of a suture anchor of FIG.22;

FIG. 24 is a cross-sectional view of the suture anchor of FIG. 22implanted in a selected portion;

FIG. 25 is an exploded perspective view of a suture anchor according toa further alternative embodiment; and

FIG. 26 is a cross-sectional view of the suture anchor of FIG. 25implanted in a selected portion.

DETAILED DESCRIPTION OF VARIOUS EMBODIMENTS

The following description of various embodiments is merely exemplary innature and is in no way intended to limit the invention, itsapplication, or uses. Although the following is related generally to asuture anchor that can be positioned in a pre-drilled hole, that is ahole provided in the boney structure for acceptance of the sutureanchor, it will be understood that a suture anchor including animpacting tip or self-drilling thread may be provided as well. Moreover,it will be understood that the suture anchor, as described and claimedherein, can be used with any appropriate surgical procedure. The variousembodiments described herein are merely exemplary and are not intendedto be limiting on the claims appended hereto.

With reference to FIGS. 1-3, a suture anchor 10 according to anembodiment of the present invention, is illustrated. The suture anchor10 generally includes a bone engaging or threaded section 12 and asuture engagement or eyelet section 14. Defined along the boneengagement section 12 is a bone engaging structure or portion, such as athread 16. The thread 16 is able to engage the bone to hold the anchor10 in a selected position.

The threads 16 may be designed in any appropriate fashion. For example,the threads 16 may include a substantially parallel or planar surface,such as the surface generally facing the suture engagement portion 14 tosubstantially fix the anchor 10 within the bone. Formed on an end of thebone engaging section 12 is a tip 18 that allows for ease of entry ofthe anchor 10 into a selected bone portion. The tip 18 may be formed tosubstantially ease entry of the anchor 10 into the boney portion or maybe formed to allow the anchor 10 to be substantially self-drilling orself-tapping. Therefore, the tip 18 may be formed to be substantiallysharp or to be any other appropriate design to allow for ease of entryof the anchor 10 into the selected boney portion.

The anchor 10 may be formed of any appropriate material. For example,the anchor 10 may be formed of a polymer, such as polylactic acidexemplary sold by Biomet, Inc. of Warsaw, Ind. as LACTOSORB. Any otherappropriate bio-absorbable material may also be used to form the anchor10. Also, the anchor 10 may be formed of any appropriate bio-compatiblematerial. For example, the suture anchor 10 may be formed of a metal,such as titanium, stainless steel, or alloys of cobalt, chromium, etc.Regardless, the anchor 10 is formed such that it will have a selectedpull-out strength to substantially hold the suture anchor 10 in positionafter the suture anchor 10 has been implanted into the bone.

The suture engaging or eyelet section 14 of the suture anchor 10includes an area to receive a suture or a portion of a suture. Thesuture eyelet section 14 includes a first eyelet or bore 30 and a secondeyelet or bore 32. Interconnecting the first eyelet 30 and the secondeyelet 32 is a suture passage 34. The suture passage 34 includes a firstpassage portion 34 a a second suture passage portion 34 b and a thirdsuture passage portion 34 c. The suture passage 34 interconnects thefirst suture eyelet 30 and the second suture eyelet 32. The first suturepassage portion 34 a interconnects the first eyelet 30 and the secondsuture passage portion 34 b. The third suture passage portion 34 cinterconnects the second eyelet 32 and the second passage portion 34 b.This allows a single suture portion to pass through both the firstsuture eyelet 30 and the second suture eyelet 32.

The suture eyelet section 14 further includes a third suture eyelet 40and a fourth suture eyelet 42. The third suture eyelet 40 and the fourthsuture eyelet 42 are also interconnected by a suture passage 44. Thesuture passage 44 includes a first hidden section 44 a that extends fromthe third suture eyelet 40. An exposed or second passage region 44 b andfinally a third passage region 44 c which interconnects with the fourthsuture eyelet 42 with the second passage portion 44 b. Therefore, thethird suture eyelet 40 and the fourth suture eyelet 42 are alsointerconnected by the second suture passage 44.

As illustrated more clearly herein, a suture may be passed from thefirst suture eyelet 30 to the second suture eyelet 32 through the firstsuture passage 34. Similarly, a second suture, or the same suture, butonly a different portion thereon, may be passed from the third sutureeyelet 40 to the fourth suture eyelet 42 through the second suturepassage 44. In the hidden passage regions 34 a, 34 c, 44 a, 44 c thesuture portion is generally completely contained within the sutureeyelet section 14. Similarly the suture is within the boundaries of thesuture anchor in the second passage portions 34 b, 44 b, but the exposedpassage regions 34 b and 44 b allow for visualization of the suture.

Formed in the suture eyelet section 14 is a tool operable portion whichincludes a first tool operable region 46 and a second tool operableregion 48. The first tool operable region 46 and the second tooloperable region 48 to allow a tool, such as a forked tool to interactwith the suture eyelet section 14 of the suture anchor 10 for insertionof the suture anchor 10 into a boney portion. It will be understood,however, that the suture eyelet section 14 may include any appropriatetool operable design. For example, the suture eyelet section 14 mayinclude a substantially hexagonal perimeter to be received within asubstantially hexagonal socket or drive tool. As a further example,various recesses may be formed substantially on the end of the sutureeyelet section 14 to be operated by a tool such as a screw driverincluding a complimentary blade to drive the suture 10 into the selectedboney portion. Generally, any appropriate means or device may be used todrive the suture anchor 10 into the selected boney portion.

The suture passage 34 includes the second passage portion 34 b thatinterconnects the first passage portion 34 a and the third passageportion 34 c. This allows a suture to be passed through the sutureengaging section 14 between the first eyelet 30 and the second eyelet32.

The suture passageways 34, 44 allows for the suture to be substantiallycontained within the suture engaging section 14 save for when the sutureextends from the suture eyelets 30, 32, 40, 42. The suture passageway34, 44 substantially contains the suture within the suture engagingsection 14 such that the bone, into which the suture anchor 10 ispositioned, does not easily engage or touch the suture. This decreasesthe possibility that bone engagement by the suture will harm the suturestrength and longevity. Also, the suture passageway 34, 44 allows forcontainment of the suture only within the suture engaging section 14.Therefore, the suture does not pass through the bone engaging section 12either before threading of the suture or after implantation of thesuture anchor 10 into the bone. Also, the suture eyelets 30, 32, 40, 42allow the suture to extend from the suture anchor 10 substantiallyparallel or along an axis of the suture anchor 10. The axis of thesuture anchor 10 is generally substantially parallel or along the axisof the bore into which the suture anchor 10 is positioned. Therefore,the suture is able to extend from the suture anchor 10 substantiallyparallel with the bore formed in the boney portion.

With reference to FIGS. 4-6, a suture anchor 100 according to a secondembodiment is illustrated. The suture anchor 100 is generally similar tothe suture anchor 10, described in FIGS. 1-3, save for features that arenoted herein. Therefore the description of similar features will beabbreviated. The suture anchor 100 includes a bone engagement orthreaded section 102 and extending from the bone engagement section 102is a suture engagement section 104. Formed on the bone engagementsection 102 is bone engaging portion such as a thread 106, although itwill be understood that any appropriate bone engaging portion or devicemay be used to hold the suture anchor 100 in-place. Formed at an end ofthe bone engaging portion 102 is a tip 108. As discussed above, the tip108 may be a self-drilling and tapping tip or may simply be a tip toallow for ease of insertion of the suture anchor 100 into the boneyportion.

The suture engaging section 104 includes a first suture eyelet 120 and asecond suture eyelet 122. The first suture eyelet 120 and the secondsuture eyelet 122 are interconnected by a suture passage 124. The suturepassage 124 includes a first suture passage portion 124 a, a secondsuture passage portion 124 b, and a third suture passage portion 124 c.The second suture passage portion 124 b is generally accessible from theexterior of the suture eyelet section 104. The first suture passagesection 124 a and the third suture passage section 124 c, however, aregenerally not accessible through the exterior of the suture eyeletsection 104, save for through the first suture eyelet 120 and the secondsuture eyelet 122. Therefore, a suture may be passed from the firstsuture eyelet 120 to the second suture eyelet 122 through the suturepassage 124. Generally, the suture eyelet passage 124 substantiallyencloses the suture, as described further herein with the first passageportion 124 a and the third passage portion 124 c. Nevertheless, thesuture is substantially viewable and accessible through the open portion124 b of the suture passage 124.

The suture eyelet section further includes a third suture eyelet 130 anda fourth suture eyelet 132. The third suture eyelet 130 and the fourthsuture eyelet 132 are also interconnected by a suture passage 134. Afirst suture passage portion 134 a interconnects the first suture eyelet130 and a second suture passage portion 134 b. Extending from the secondsuture passage portion 134 b is a third suture eyelet passage portion134 c. A suture may be passed from the third suture eyelet 130 to thefourth suture eyelet 132 through the second suture passage 134.

The first suture passage 124 including the exposed section 124 bgenerally defines a suture turnaround surface area T. It will beunderstood that the second suture passage 144 also includes a secondsuture turnaround area T′. The area of the suture turnaround T can beany selected length or surface area. Moreover, the turnaround T may beformed of any appropriate geometry, that is illustrated exemplary asbeing substantially parallel with the top of the suture eyelet section104. As will be discussed further herein, the suture that is passedthrough the suture passage 124, which the suture anchor 100 anchorsrelative to a bone portion, generally engages the turnaround area T.Therefore, the turnaround area T, may be any selected surface area tosubstantially hold the suture in the suture passage 124. Furthermore, itwill be understood that the first turnaround T and the second turnaroundT′ may be different or the same in surface area or size. The surfacearea or size of the turnaround T, T′ may be selected depending upon thesuture material chosen, the application of the suture anchor 100 orother appropriate considerations.

Also formed in the suture eyelet section 104 is a first tool operableportion 140 and a second tool operable portion 142. The tool operableportions 140 and 142 are generally able to be operated by asubstantially forked tool. The forked tool can transfer a torque fromthe tool to the suture anchor 100 to allow for insertion of the sutureanchor 100 into the boney portion. It will be understood, that anyappropriate tool operable portion or geometry may be formed into thesuture eyelet section 104. For example, the suture eyelet portion 104may generally define a hexagonal cross-section to be received within ahexagonal driver.

With reference to FIGS. 7-10, a suture anchor 200 according to a thirdembodiment is illustrated. The suture anchor 200 is similar to thesuture anchor 10 illustrated in FIGS. 1-3 and similar portions thereofwill be described in an abbreviated manner. The suture anchor 200generally includes a bone engaging section 202 and a suture engagingsection 204. The bone engaging section 202 is generally able to bedriven into a bone by use of a tool.

The bone engaging section 202 includes a bone engaging member or portionsuch as a thread 206. It will be understood that the thread 206 may beany appropriate bone engaging portion and the thread 206 is merelyexemplary. Moreover, the thread 206 may be formed in any appropriateshape or size to engage the bone. At the end of the bone engagingsection is a tip 208. The tip 208 allows for ease of entry andengagement of the suture anchor 200 into the selected boney portion. Thetip 208 may be substantially sharpened or generally pointed to allow forease of entering the suture anchor 200 into the bone. Nevertheless, thespecific design of the tip 208 may be any selected design to allow forinsertion of the suture anchor 200 into the bone. For example, the tip208 may be designed to allow for easy starting of a self-drilling sutureanchor. Similarly, the thread 206 may interact with the tip 208 to allowfor ease of a self-tapping or self-drilling suture anchor.

The suture engaging section 204 includes an area to substantiallyreceive a portion of a suture. The suture engagement section generallyincludes a first eyelet 220 and a second eyelet 222. A suture passage224 interconnects the first suture eyelet 220 and the second sutureeyelet 222. The passage 224 includes a first passage section 224 a whichextends from the first eyelet 220. A second passage portion 224 b thatextends from the first passage section 224 a and interconnects it with athird section 224 c of the suture passage 224. In this way, a suture canbe passed from the first eyelet 220 through the suture passage 224 tothe second eyelet 222. The second passage section 224 b includes a firstaperture 226 and a second aperture 228. In this way, the suturepositioned in the suture passage 224 can be viewed through the firstaperture 226 or the second aperture 228.

The suture engagement section 204 further defines a tool operable area230 and 232. The tool operable areas 230 and 232 allow for a tool todrive the suture anchor 200 into a selected bone. In this way, thesuture anchor 200 can be driven into a bone while a portion of a sutureis held within the passage 224.

As illustrated, the suture passage 224 generally allows the suture to bemaintained within an exterior wall of the suture anchor 200. Therefore,a suture positioned through the suture passage 224 would generally notbe pressed or wedged between the suture anchor 200 and a bone portion asthe suture anchor 200 is being driven into the bone.

With reference to FIGS. 11-15, a suture anchor 300, according to afourth embodiment, is illustrated. The suture anchor 300 generallyincludes a bone engaging section 302 and a suture engaging section 304.The bone engaging section 302 includes the bone engaging portion, suchas a thread 306. It will be understood that the thread 306 is merelyexemplary of any appropriate bone engaging portion that can be used tofix the suture anchor 300 in the bone. Extending from an end of the boneengaging section 302 is a tip 308. The tip 308 may be formed in anyappropriate manner depending upon the use of the suture anchor 300. Thetip 308 may be substantially sharpened and assist in a self-tapping andself-drilling suture anchor. Alternatively, the tip 308 may simply allowease of insertion of the suture anchor 300 into a pre-drilled hole.

With reference to FIG. 12, the thread 306 is formed to allow forsubstantial fixation of the suture anchor 300 into the bone. Forexample, the thread 306 may include a substantially planar proximal edge310. The planar edge 310 assists in holding the suture anchor 300 in theselected portion of the bone. In addition, the thread 306 may define asubstantially radius portion 312 extending between the thread 306 turns.A bottom edge 314 of the thread 306 may be formed at an angle relativeto the top surface 310 of an adjacent thread. It will be understood,that the thread may be formed in any appropriate manner to allow forfixation of the suture anchor 300 into the bone.

The suture engaging section 304 generally defines a tool operablesection including a first tool operable section 316 and a second tooloperable section 318. Tool operable sections 316, 318 can be used toallow a tool to transfer torque to the suture anchor 300 to drive thesuture anchor 300 into a selected boney portion. It will be understoodthat any appropriate tool operable section may be formed on the sutureanchor 300. For example, the suture engaging section 304 may be formedwith a substantial hexagonal cross-section to be driven with a hexdriver.

The suture engaging section 304 further defines a first suture eyelet320 and a second suture eyelet 322. A suture passage 324 interconnectsthe first suture eyelet 320 and the second suture eyelet 322. Extendingfrom the first suture eyelet 320 is a first suture passage section 324a. The first suture passage 324 a extends through an exterior side ofthe suture engaging section 214 and forms a first suture portal 325 a.Extending from the first suture passage 324 a, and generallyperpendicular to a central axis X of the suture anchor 300 is a secondsuture passage portion 324 b. The second suture passage 324 b may beaccessed through said first suture portal 325 a. Extending from thesecond suture passage portion 324 b and to the second suture eyelet is athird suture passage portion 324 c. The second suture passage 324 b andthe third suture passage 324 c also extend through an exterior of thesuture engaging section 304 forming a second suture portal 325 b. Boththe second suture passage 324 b and the third suture passage 324 c maybe accessed through the second suture portal 325 b.

The suture passage 324, including the various portions, allows for asuture to be passed from the first suture eyelet 320 to the secondsuture eyelet 322 and be held substantially within an outside perimeterof the suture anchor 300. In this way, the suture anchor 300 can beimplanted into a selected boney portion while containing a suturetherein and not binding the suture with the bone during implantation.

The first passage portion 324 is formed generally along an axis A thatis formed at an angle to the axis X of the suture anchor 300. Thus thefirst suture portal 325 a is formed on a side of the suture engagingsection 304 adjacent the first suture eyelet 320. The second passageportion 324 b is formed generally along an axis B that is illustratedoutside of the suture anchor 300 for clarity. Furthermore, the thirdsuture passage section 324 c is formed generally along a third axis Cwhich is also formed at an angle with the axis X of the suture anchor300 such that the second suture portal 325 b is adjacent the secondsuture eyelet 322. The first axis A and the second axis B define alsodefine angle α. A congruent angle α′ is also defined by the first axis Aand the second axis B. Similarly, axis B and axis C define an angle βand a congruent angle β′. The angles formed by the various axes A, B, Cgenerally define the path which is traveled by the suture as it isthreaded through the suture anchor 300. The angles α, α′, β, β′ alsodefine the changes in direction and the degree of bend of the suturepassage 324 through its path.

A suture S may be easily threaded through the suture passage 324 bytraveling through the various sections of the suture passage. The anglesα, α′, β, and β′ allow for ease of travel of the suture during anythreading process, particularly during a surgical procedure. The variousangles α, α′, β and β′ are generally greater than or equal to 90°. Theseobtuse angles allow the suture to be easily passed through the suturepassage 324 during an operative procedure. Moreover, the angles of axisA and C allow the suture to be passed to the exterior of the sutureengaging section 304 to ease threading of the suture. For example, thesuture anchor 300 may generally be about 5 to about 20 mm long and about1 to about 5 mm across. Therefore, in this example, the area within thesuture engaging portion 304 is substantially small and tight and allowsfor only minute movements of the suture. Therefore, the suture passage324 allows for an ease of threading of the suture during any procedure,particularly one being formed by a physician during a surgicalprocedure.

With particular reference to FIG. 15, an exemplary threading of thesuture S is illustrated. The suture S may be passed through the firstsuture eyelet 320 in the direction of arrow S₁. The suture is passedthrough the first suture eyelet 320 and through the first suture passageportion 324 a of the suture passage 324. Generally, the suture may bestiffened or include a needle N on the end being passed through thefirst suture passage 324. Nevertheless, the suture may be passed throughthe first suture portal 325 a to the exterior of the suture anchor 300where it may be grasped by an individual. A notch or cutout 326 may beprovided to allow for ease of maneuvering of the suture needle N fromthe first suture passage section 324 a to the exterior of the sutureanchor.

The needle N, to which the suture S is affixed, may then be turned andpassed through first suture portal 325 a and the second suture passagesection 324 b in the direction of the arrow S₂ with ease at an angle ofat least about 90° and generally greater than about 90°. The secondsuture passage section 324 b generally extends to through an exteriorportion of the suture engaging section 304 at the first suture portal325 a. Therefore, the suture needle N and a portion of the suture S canbe passed to the exterior of the suture anchor 300. This also allows thesuture needle N to be passed from the exterior back through the interiorand through the second suture passage portion 324 b.

The suture can then be passed through the second side of the sutureanchor 300 through the second suture portal 325 b. Again, as discussedabove, the second suture passage section 324 b extends generally throughan edge or exterior of the suture anchor 300 at the second suture portal325 b. Once the suture needle N and the portion of the suture S ispassed to the exterior of the suture anchor 300 it again gain may beturned to pass through the third suture passage section 324 c. A secondcutout 328 may be provided adjacent the second passage portion 324 b andthe second suture portal 325 b to allow for ease of maneuvering of thesuture needle N during the threading procedure. Nevertheless, the sutureneedle N and the portion of the suture S can be passed in the directionof the arrow S₃ through the third suture passage section 324 c andfinally out the second suture eyelet 322.

Thus, the suture S can be threaded through the suture passage 324substantially easily without binding of the suture S during thethreading procedure. As illustrated particularly in FIG. 16C the sutureS, after being threaded through the suture passage 342 does not includeany angle less than 90°. As discussed above the suture S is exposed tothe angles α, α′, β and β′ that are all greater than or equal 90°. Thisallows for a substantially ease and non-binding threading of the sutureS through the suture passage 324. These angles also provide that thefirst suture passage section 324 a extends through the first sutureportal 325 a in the suture engaging section 304 and the third suturepassage section 324 c extends through the second suture portal 325 b inthe suture engaging section 304.

Simply, a portion of the suture S which may include a suture needle Nmay be threaded through the various sections of the suture passage 324to allow for threading of the suture anchor 300 prior to implantation ofthe suture anchor 300 into the bone. Also, once the suture S is threadedthrough the suture anchor 300 substantially no portion of the suture Sextends beyond an exterior of the suture anchor 300 save for the portionof the suture S that extends through the eyelets 320, 322. This allowssubstantially the entire suture anchor 300, including the bone engagingsection 302 and the suture engaging portion 304, to be driven into aboney portion to substantially secure the suture S at a selectedposition.

With reference to FIG. 17, the suture anchor 300 may be operablyimplanted into a bone 350 using a tool 360. It will be understood thesuture anchor 300 may be implanted in any appropriate manner and thefollowing is simply exemplary. The tool 360 may generally include acannulated shaft or suture anchor driving portion 362. Extending fromthe shaft 362 is a handle 364. The handle 364 can be graspable by anindividual or may be formed such that it may be grasped by a machine,such as a drill motor or other appropriate driver. The cannulated rod362 and the handle 364 allow for engagement of a length of the suture Sfor easy manipulation of the suture after implantation of the sutureanchor 300. As exemplary illustrated, the suture driving tool 360includes a suture anchor fork leg 366 that exemplary allows for the tool360 to operably drive or manipulate the suture anchor 300. Nevertheless,as discussed above, any appropriate mechanism may be provided to allowfor a transfer of a torque and driving force from the tool 360 to thesuture anchor 300.

The suture anchor 300 may be threaded and operably positioned adjacentthe tool 360 either preoperatively or during the operative procedure.Therefore, it may either be factory loaded or may be loaded by aphysician after a choice of a selected suture anchor has been made. Aportion of the suture S may be threaded through the suture anchor 300and passed through the tool 360 to allow for ease of manipulation of thesuture anchor 300 during implantation. After the suture anchor 300 isoperably associated with the tool 360, a torque and driving force may beprovided to the suture anchor 300 to drive it into a selected boneportion 350.

The bone 350 exemplary includes a pre-drilled hole 368 to receive thesuture anchor 300. Nevertheless, it will be understood that the bone 350may be provided without the pre-drilled hole 368 and the suture anchor300 may be formed to be self-drilling, self-tapping, or an impact type.Nevertheless, the tool 360 allows the suture anchor 300 to be driveninto the pre-drilled hole 368. Once the suture anchor 300 is driven intothe pre-drilled hole 368, the suture S may be released from the tool 360and the tool 360 removed from the suture anchor 300. With particularreference to FIG. 18, when fully implanted, the suture anchor 300 issubstantially completely received within the bone 410. That is, theouter surface of the bone 350 is generally coplanar with a top 305 ofthe suture engaging section 304. Thus, the suture anchor 300 does notsubstantially interrupt the surface of the bone 350.

Disengaging the suture S from the tool 360 frees the tool form thesuture anchor 300. It also allows the suture S to be manipulated by thephysician during the procedure to substantially anchor any selectedportion or graft. For example, the suture anchor 300 may be used to tiedown an end of a portion of soft tissue, such as a tendon or ligament.

The suture anchor may be formed of any appropriate material. The sutureanchor 300 may be formed of a polymer material, that is eitherabsorbable or non-resorbable, or of a bio-compatible metal. If thesuture anchor is formed of an absorbable material, then as the materialof the suture anchor is absorbed, bone or biological material may growinto the pre-drilled hole 412. Therefore, a substantially permanentbiological fixation of the suture portion or the soft tissue may beformed. Nevertheless, the suture anchor can provide a temporary orpermanent fixation of a portion of a suture in an area of a bone that isnot included in area that can be easily sutured.

With reference to FIGS. 19-21, a bone anchor 400 according to analternative embodiment is illustrated. The bone anchor 400 includes asuture engaging or holding section 402 and a bone or anatomical engagingsection 404. The suture engaging section 402 includes a distal tip orexpander portion 406 and a proximal eyelet portion 408. The distal endportion 406 exemplary terminates in a tip or point 410 to assist ininsertion of the suture anchor 400, as discussed further herein.Nevertheless, for final insertion of the suture anchor 400, the sutureengaging section 402 is substantially contained within the bone engagingsection 404, as described further herein. The distal end tapers from thetip 410 to a maximum diameter annular ring 412. Extending proximallyfrom the ring 412 is at least one rib or protuberance 414. Theprotuberance 414 assists in guiding the suture engaging section 402through the bone engaging section 404 for final implantation of thesuture anchor 400.

In the eyelet portion 408 of the suture engaging section 402 is formed asuture eyelet 416. The suture eyelet 416 generally includes a firstsuture portal 418 and a second suture portal 420. The suture portals418, 420 allow a suture to be passed through the eyelet 416 to allow forthe suture engaging section 402 to hold the suture relative to thesuture anchor 400. A first suture passage 421 interconnects the twosuture portals 418, 420 to allow a suture to pass through the sutureengaging section 408.

Extending from the suture portal 418 towards the proximal end of thesuture anchor 400 is a second suture passage 422. The second suturepassage 422 allows the suture to be held within an external diameter ofthe suture engaging section 402. This assists in substantiallyeliminating or decreasing abrasion of the suture between the sutureengaging section 402 and the bone engaging section 404.

Extending proximally from the suture eyelet portion 402 is a pop orsetting member 426. The pop section 426 assists in setting the sutureanchor 400 within a selected portion of the boney structure, asdescribed further herein. The pop section 426 can be removed from thesuture engaging section 402 during or after implantation of the sutureanchor 400 into the selected boney portion.

The engaging section 404 includes a distal end 430 and defines at leastone deflectable flange or member 432. The flange 432 is deflectablerelative to the bone engaging section 404 due to at least a slot 434defined by the bone engaging section 404. The deflectable member 432further defines at least a first ridge or bone engaging projection 434.The bone engaging projection 434 assists increasing the pullout strengthof the suture anchor 400 after implantation of the suture anchor 400. Adistal end 440 of the suture anchor 404 is substantially continuous andcan define any appropriate shape. The distal end 440 allows thedeflectable members 432 to deflect relative to the bone engaging section404 while keeping the deflectable members substantially aligned and heldrelative one another.

With reference to FIGS. 20-21, and preparation of implanting the sutureanchor 400, the suture engaging section 402 is pulled into the interior442 defined by the bone engaging section 404. Prior to pulling thesuture engaging portion 404 into the bone engaging portion 402, a sutureS is passed through the eyelet 416. The suture S may be held in thesecond suture passage 422 to limit binding or engagement with theinterior 442. This also helps ensure the suture S extends from theproximal end 440 of the bone engaging section 404 substantiallyvertically or aligned with the suture engaging section 402. The sutureengaging section 402 is generally pulled into the interior 442 of thebone engaging section 404 until the proximal taper 415 of the sutureengaging section engages a distal end 433 of at least one of thedeflectable members 432. This substantially readies the suture anchor400 to be implanted into a selected boney portion 444.

Generally, the selected boney portion 444 generally includes a bore 446into which the suture anchor 400 is implanted. The suture anchor 400 isthen driven into the bore 446 defined by the bone 444 a selecteddistance. After the suture anchor 400 is driven into the bore 448 theselected distance, the pop portion 426 is pulled proximally through theinterior portion 442 of the bone engaging section 404. This pulls thedistal end 406 of the suture engaging section 402 towards the boneengaging section 404. This, in turn, deflects the deflectable members432 outwardly from the bone engaging section 404. Therefore, thedeflectable members 432 further engage the bone and the bone engagingridges 434 substantially hold the suture anchor 400 in the selectedposition. At a selected time, the pop section 426 is removed from thesuture engaging section 402. At this point, the suture S issubstantially held in place as the suture engaging section 402 is lockedwithin the bone engaging section 402 thereby deflecting the deflectablemembers 432 to engage the bone 444. The distal end 440 of the boneengaging section 404 also protects the suture S from engagement with thebone 444. Therefore, after implantation, the suture S is substantiallyprotected from engagement with the bone 444 to substantially reduce oreliminate wear of the suture S because of movement against the bone 444.

The pop portion 426 can generally be provided to pop or dislocate fromthe suture engaging section 402 at any selected point. That is, the popsection 426 would generally dislocate or release from the sutureengaging section 402 when a selected pressure is formed between thedeflectable members 432 and the bone 444. Therefore, a selected holdingpower of the suture anchor 400 can be determined. Moreover, the pressurecreated between the deflectable members 432 and the bone 444 can beselected depending upon the selected bone or the condition of the boneinto which the suture anchor 400 is implanted.

With reference to FIGS. 22-24, a suture anchor 500 according to analternative embodiment is illustrated. The suture anchor 500 includes abone engaging section 502 and a suture and expander section 504. Thesuture anchor 500 is adapted to be able to be driven into a preformedbore in a bone to hold a suture in a selected position. Although it willbe understood that the suture anchor 500 may also be driven into anunprepared bone as well.

The suture engaging section 504 includes a distal tip 506 which is anapex of a cone or expander portion 508. The expander portion 508terminates in a proximal ridge or shoulder 510. Extending furtherproximally is a suture engaging portion 512 which defines a sutureeyelet 514. The suture eyelet 514 includes a first suture portal 516 anda second suture portal 518 to allow a suture to pass through the sutureengaging section 512. A suture passage 520 extends between the sutureportals 516 and 518 interconnecting them such that the suture can passthrough the suture engaging section 512. Extending from each of theportals 516, 518 is a suture guiding path 522. The suture guiding path522 allows a suture to be held relative to the suture engaging section512 without engaging the bone engaging section 502 tightly.

The bone engaging section 502 includes a distal end 530 and a proximalend 532. Formed between the distal end 530 and the proximal end 532 isat least a single flexible or deflectable member 534. The flexiblemember 534 is able to flex or move relative to the bone engaging section502 to engage a boney portion. The flexible finger 534 includes aninterior wall 536 that defines an angle α relative to a plane defined bythe proximal end 532. Thus, as the suture engaging expander section 504is drawn into the bone engaging section 502 in the direction of arrow A,the ridge 510 engages the interior wall 536 and pushes it out as itrides along the wall 536 because of the angle α. In turn, this forces anexterior wall 538 of the flexible portion 534 beyond an exterior wall540 of the proximal end 532. This assists in holding the suture anchor500 in a boney portion and to substantially hold a suture in place.

With reference to FIG. 24, after the expander portion 502 has been drawninto the bone engaging section 502, the flexible fingers 534substantially engage a bone 550 into which the suture anchor 500 isimplanted. The expander ridge 510 pushes the flexible portions 534 tosubstantially engage the bone. The suture S which was previously passedthrough the suture eyelet 514 and drawn through the bone engagingportion 502 is also held in place. Therefore, the suture S issubstantially anchored within the bone 550. The bone engaging section502 defines a buffer or contact area such that the suture S does notengage the bone 550 after implantation of the suture anchor 500.Therefore, the suture S is protected from contact with the hard andrough cortical bone by the suture anchor 500. Also, the internal passageof the suture S through the bone engaging section 502 allows the sutureS to extend substantially vertically from the bone 550 and aligned withthe suture engaging section 504.

The suture anchor 500 can be formed of any appropriate material, such asa polymer or other suitable biocompatible material such as a metal, forexample stainless steel or cobalt chromium alloys. Nevertheless, thesuture anchor 500, particularly the bone engaging section 502, issubstantially non-abrasive such that contact of the bone engagingsection 502 with the suture S does not substantially damage the sutureS. Moreover, the suture anchor 500 may be formed of a bio-absorbablematerial such that over time the suture anchor 500 will absorb into thebody leaving the suture S anchored in bone ingrowth growing from thebone 500 or the tissue to which the suture is connected is permanentlyhealed and affixed to a selected bone portion.

With reference to FIGS. 25-26, a suture anchor 600, according to analternative embodiment, is illustrated. The suture anchor 600 includes afirst or bone engaging section 602 and a second or suture engagingsection 604.

The suture engaging section 604 includes a distal end 606 that issubstantially pointed to assist in implanting the suture end 600. Thesuture engaging end 604 tapers to a shoulder or edge portion 608 thatincludes an external diameter that is greater than an external diameterof a distal end 610 of the bone engaging section 602. As discussedfurther herein, this allows the suture engaging section 604 to be heldfirmly by the bone engaging section 602. The distal end 606 of thesuture engaging section 604 also assists in driving or piercing throughcortical bone. Therefore, the suture anchor 600 can be provided as aself-drilling and self-tamping suture anchor. The distal end 606 can besubstantially and tough to easily pierce the cortical bone.

The suture engaging section 604 further defines a suture eyelet 612through which a suture S may pass. The suture eyelet 612 is positionedin a proximal end 614 of the suture engaging section 604 that includesat least one dimension smaller than a distal portion 616 of the sutureengaging section 604. Generally, the suture engaging section 604 maytaper smaller from the distal portion 616 to the proximal portion 614.Therefore, the suture that is passed through the suture eyelet 612 doesnot bind on the bone engaging section 602 as the suture engaging section604 is passed through the bone engaging section 602.

The bone engaging section 602 defines a bone engaging structure, such asthreads 620. The threads 620 may include any appropriate pitch andthread depth to securely engage a bone 630. The bone engaging section602 further includes a proximal end 622 which defines a tool engagingsection 624, such as a hex bore. In this way, a tool may engage the boneengaging section 602 to drive the suture anchor 600 into the bone 630.

The suture engaging section 604 may have a suture S passed through thesuture eyelet 612. The suture S can be passed through the bone engagingsection 602 through the internal bore and the suture engaging section604 follow after. The shoulder 608 can then engage the distal end 610 ofthe bone engaging section 602 to hold it in place as the bone engagingstructure 620 engages the bone 630. In this way, the suture engagingsection 604 is held substantially in place in the selected portion ofthe bone 630.

Furthermore, the tool engaging section 624 may have a diameter greaterthan the proximal end 614 of the suture engaging section such that acannulated tool may engage the tool engaging bore 624 while not engagingthe suture engaging section 604. In this way, the bone engaging section602 can be rotated while not rotating the suture engaging section 604.The tool may be cannulated such as the sutures may be passed through thetool so that as the tool rotates the bone engaging section 602, thesuture S does not become tangled because the suture engaging section 604does not rotate. The suture engaging section 604 includes the distalshoulder 608 that engages a distal end of the bone engaging section 602such that driving in the bone engaging section 602 simultaneously drivesin the suture engaging section 604. Therefore, the suture anchor 600allows the suture anchor 600 to be driven into the bone 630 by rotatingthe bone engaging section 602 and not rotating the suture engagingsection 604. It will be understood, however, that both the sutureengaging section 604 and the bone engaging section 602 may besimultaneously engaged to insert the suture anchor 600.

The suture anchor 600 can be formed of any appropriate material, such asa polymer or a biocompatible metal such as stainless steel or cobaltchromium alloys. Therefore, the suture anchor 600 can either beself-tapping or self-drilling or screwed into a prepared and tapped boreformed in the bone 630. Nevertheless, according to any formation, thesuture S passes from the suture anchor 600 without engaging the bone630. The suture S is substantially protected from engagement with thebone 630 after implantation of the suture anchor 600 into the bone 630thereby able to increase the longevity of the suture S. The suture Sextends generally aligned with the suture engaging section 604 withinthe bone engaging section 602 to protect the suture S from engagementwith the bone 630. The distal tip 606 can further assist in theself-drilling of the suture anchor 600 by being substantially sharpenedor including a self-drilling point.

According to any of the embodiments, an appropriate tool may be used toinsert the suture anchor into a selected portion of the bone. Each ofthe suture anchors 400 and 500 can be pushed into a preformed bore inthe bone and the tool used to pull the suture engaging section into thebone engaging section to expand the flexible members to substantiallyhold the suture engaging section and the bone engaging section relativeto the bone.

The suture anchor 600, in addition to the threaded suture anchors 10,100, 200, and 300 can be drilled or screwed into a selected boneportion. Either the threaded or screwed devices can be self-drilling andtapping or be positioned into a bore which is tapped in the bone.Nevertheless, any of the suture anchors can be appropriately positionedin the bone to hold a suture in a selected position. Nevertheless, eachof the suture anchors provides a buffer or protection area tosubstantially protect the suture S from the bone into which the sutureanchor is positioned. The suture extends substantially vertically oraxially with the suture anchor such that the suture does not bind orsubstantially engage the bone surrounding the suture anchor. In thisway, the suture is protected from the engagement with the hard corticalbone, generally the bone into which the suture bone is implanted, whichmay increase the longevity of the suture and decrease the requirementsof revision procedures to replace damaged suture.

The description of the invention is merely exemplary in nature and,thus, variations that do not depart from the gist of the invention areintended to be within the scope of the invention. Such variations arenot to be regarded as a departure from the spirit and scope of theinvention.

1. A suture anchor, comprising; a bone engaging section formed along abone engaging axis; a bone engaging structure formed along said boneengaging section and defining a maximum diameter of the suture anchor; anon-threaded suture engaging section extending from said bone engagingsection to a terminal proximal end of the suture anchor and wherein anoutermost annular surface of the suture engaging section defines adiameter less than or equal to said maximum diameter, such that saidsuture engaging section is able to be substantially disposed below anexterior surface of a boney structure after implantation; a first eyeletand a second eyelet both formed as a completely surrounded bore in aproximal face of said suture engaging section, said first and secondeyelets allowing a selected portion of a suture to pass through andextend from said suture engaging section generally along said boneengaging axis; and a suture passage including first, second and thirdsuture passage portions that are all defined entirely by said sutureengaging section, wherein said suture passage interconnects said firstand second eyelets and is operable to allow a suture to enter and exitsaid suture engaging section from a single section such that theselected portion of the suture remains substantially within said maximumdiameter, wherein said first suture passage portion extends from saidfirst eyelet along a first axis, said second suture passage portionextends through said outermost annular surface along a second axis thatis generally perpendicular to said bone engaging axis and interconnectssaid first suture passage portion and a third suture passage portion,said third suture passage portion extending from said second eyeletalong a third axis, wherein said first and third axes both diverge fromeach other from said terminal proximal end and both form exterior obtuseangles with said second axis.
 2. The suture anchor of claim 1, whereinsaid bone engaging section and said suture engaging section aresubstantially integrally formed as a single unit.
 3. The suture anchorof claim 2, wherein the material of said single unit is selected from agroup including stainless steel, cobalt chromium alloys, bio-absorbablepolymers, and combinations thereof.
 4. The suture anchor of claim 1,wherein said bone engaging structure includes a thread formed along saidbone engaging section, wherein a maximum diameter of said thread definessaid maximum diameter of the suture anchor.
 5. The suture anchor ofclaim 4, wherein said thread is formed only on said bone engagingsection.
 6. The suture anchor of claim 1, wherein: said first and secondeyelets are substantially exposed and accessible after implantation ofthe suture anchor.
 7. The suture anchor of claim 1, wherein said firsteyelet and said second eyelet are arranged relative to said suturepassage such that a suture may be passed through said first eyeletthrough said passage and through said second eyelet and be heldsubstantially within said suture engaging section.
 8. The suture anchorof claim 7, wherein said suture passage allows a suture to be passed toan exterior of said suture engaging section at a point other than saidfirst eyelet and said second eyelet.
 9. The suture anchor of claim 1,wherein a suture passed through said suture passage is passedsubstantially only through said suture engaging section.
 10. The sutureanchor of claim 1, wherein said suture engaging section is spaced adistance axially from said bone engaging section.
 11. The suture anchorof claim 1, wherein said suture engaging section is positionedsubstantially within a boundary defined by said bone engaging section.12. The suture anchor of claim 1, wherein said bore is substantiallycylindrical.
 13. A suture anchor to provide a fixation of a suture in aselected anatomical portion, comprising: an anatomical engaging sectionhaving an anatomical engaging portion formed along an anatomicalengaging axis; and a non-threaded suture engaging section extending fromsaid anatomical engaging section to a terminal proximal end of thesuture anchor, said suture engaging section defining a radiallyoutermost surface that is configured to be substantially disposed belowan exterior surface of the selected anatomical portion afterimplantation; wherein said suture engaging section defines a firstsuture eyelet and a second suture eyelet formed in a single terminal endwall of said suture engaging section; wherein said first suture eyeletand said second suture eyelet are each operable to maintain the suturewithin a perimeter of said suture engaging section; wherein said sutureengaging section defines a suture holding passage interconnecting saidfirst suture eyelet and said second suture eyelet to substantially holda suture relative to said anatomical engaging section, said sutureholding passage being formed entirely in said suture engaging section,said suture holding passage having first, second and third suturepassage portions wherein said first suture passage portion extends fromsaid first eyelet along a first axis, said second suture passage portionextends through said radially outermost surface along a second axis thatis generally perpendicular to said bone engaging axis and interconnectssaid first suture passage portion and a third suture passage portion,said third suture passage portion extending from said second eyeletalong a third axis, wherein said first and third axes both diverge fromeach other from said terminal proximal end and both form exterior obtuseangles with said second axis; wherein said suture engaging section isadapted to be positioned generally within a bore defined in saidselected anatomical portion.
 14. The suture anchor of claim 13, whereinsaid anatomical engaging section and said suture engaging section aregenerally formed as a single piece of a single material.
 15. The sutureanchor of claim 13, wherein a suture is positionable through said firstsuture eyelet, said suture holding passage, and said second sutureeyelet such that said suture is generally able to extend from saidsuture engaging section generally parallel and along an axis of saidanatomical engaging section.
 16. The suture anchor of claim 13, whereinsaid anatomical engaging section and said suture engaging section areadapted to be substantially received within the selected anatomicalportion such that said suture engaging section is generally co-extensivewith an exterior portion of said selected anatomical portion.
 17. Thesuture anchor of claim 13, wherein said suture holding passage includesan enclosed passage defined in said suture engaging section; wherein thesuture is operable to be held completely within said suture engagingsection via said suture holding passage.
 18. The suture anchor of claim13, wherein said first suture eyelet and said second suture eyelet areboth formed through one surface of said suture engaging section.
 19. Thesuture anchor of claim 18, wherein said first suture eyelet and saidsecond suture eyelet are each defined by a bore in the one end surfaceof said suture engaging section, wherein said bore has a sidewallenclosing a complete perimeter of said bore; wherein said suture holdingpassage extends through said suture engaging section to interconnectsaid first suture eyelet and said second suture eyelet so that a sutureis operable to pass through said first suture eyelet, said sutureholding passage, and said second suture eyelet.
 20. The suture anchor ofclaim 13, wherein said single terminal end wall is formed to intersectsaid anatomical engaging axis.
 21. The suture anchor of claim 13,wherein said first suture eyelet and said second suture eyelet are eachdefined by a bore in an end surface of said suture engaging section,wherein said bore has a sidewall enclosing a complete perimeter of thebore.
 22. A suture anchor system, comprising; a bone engaging portionformed along a bone engaging axis; a bone engaging structure formedalong said bone engaging portion and defining a maximum diameter; asuture engaging portion extending from said bone engaging portion to anend surface of the suture anchor, said suture engaging portion defininga diameter less than or equal to said maximum diameter along the lengthof the suture engaging portion; at least two eyelets formed in said endsurface of said suture engaging portion to completely surround a sutureand to allow a selected portion of the suture to pass through and extendfrom said suture engaging portion generally along said bone engagingaxis; and a suture passage defined only by said suture engaging portioninterconnecting said at least two eyelets, said suture passage havingfirst, second and third suture passage portions wherein said firstsuture passage portion extends from a first eyelet along a first axis,said second suture passage portion extends through an outermost annularsurface of the suture engaging portion along a second axis that isgenerally perpendicular to said bone engaging axis and interconnectssaid first suture passage portion and a third suture passage portion,said third suture passage portion extending from a second eyelet along athird axis, wherein said first and third axes both diverge from eachother from said end surface and both form exterior obtuse angles withsaid second axis.
 23. The suture anchor system of claim 22, wherein saidbone engaging portion and said suture engaging portion are integrallyformed as a single member.
 24. The suture anchor system of claim 22,wherein said end surface is formed at an end of said suture engagingportion configured to extend away from said bone engaging portion. 25.The suture anchor system of claim 22, wherein said suture passage isconfigured to allow a suture to pass through one of said at least twoeyelets, be positioned in said suture passage and pass through a secondof said at least two eyelets.
 26. The suture anchor system of claim 22,wherein each of said at least two eyelets is defined by a bore in saidend surface of said suture engaging portion, wherein said bore has asidewall enclosing a complete perimeter of said bore.
 27. The sutureanchor system of claim 26, wherein said suture engaging portion includesa first surface formed substantially transverse to said bone engagingaxis; wherein said at least two eyelets are both defined by said firstsurface.
 28. The suture anchor system of claim 22 wherein said sutureengaging portion is non-threaded.